| NPI | 1306053921 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: MA 233827) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: MA 230163) |
| 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: FL 9567) | |
| Enumeration Date | 2007-05-16 |
| Last Update Date | 2020-07-16 |